Preventive Dentistry Chapter 15 Copyright 2009 2006 by

Chapter 15 Lesson 15. 1 Copyright © 2009, 2006 by Saunders, an imprint of

Learning Objectives Pronounce, define, and spell the Key Terms. Explain the goal of preventive dentistry. Describe the components of a program of preventive dentistry. Assist patients in understanding the benefits of preventive dentistry. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Introduction The goal of preventive dentistry is to have a healthy mouth for a lifetime. To achieve this goal, new and recurring disease must be prevented. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

What Is Preventive Dentistry? Patient education Fluorides Dental sealants Proper nutrition Plaque-control program Optimum oral health can become a reality. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Guides for Patient Education Listen carefully: Each patient will have different needs. The initial instruction: Explain the relationship of plaque to dental disease. Assess the patient’s motivations and needs: Combine the patient’s motivating factors with the patient’s needs. Select the home cleaning aids: Select a toothbrush, toothbrushing method, interproximal cleaning aids such as dental floss, and a toothpaste. Keep the instruction simple: Comment positively on the patient’s efforts. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -1 The mother lifts the child’s lip and looks for early signs

Fig. 15 -2 The dental assistant uses the intraoral camera to aid patient education.

Chapter 15 Lesson 15. 2 Copyright © 2009, 2006 by Saunders, an imprint of

Learning Objectives Discuss techniques for educating patients in preventive care. Describe the effect of water fluoridation on the teeth. Describe the effects of excessive amounts of fluoride. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Dental Sealants Dental sealants are used as a means of protecting the difficult-to-clean occlusal surfaces of the teeth from decay. A dental sealant is a plasticlike coating that is applied over the occlusal pits and grooves of the teeth. Sealants cover the occlusal pits and fissures where decay-causing bacteria can live. Dental sealants are an important component in preventive dentistry. In several states, the application of dental sealants is delegated to the dental assistant as an expanded function. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -4 This molar is protected from decay with a dental sealant. (Courtesy

Fluoride Fluoride has been our primary weapon with which to combat dental caries for more than 40 years. Fluoride slows demineralization and enhances remineralization of tooth surfaces. Fluoride is a mineral that occurs naturally in food and water. A supply of both systemic and topical fluoride must be available throughout life to achieve the maximum cavity-prevention benefits. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Ways of Receiving Fluoride Prescription-strength fluorides are applied in the dental office. Non–prescription-strength are sold over the counter for at-home use. Fluoridated water is available bottled or through the community. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Ways of Receiving Fluoride (Cont’d) Systemic fluoride is ingested in food, beverages, or supplements. The required amount of fluoride is absorbed through the intestine into the bloodstream and transported to the tissues where it is needed. Ø Excess systemic fluoride is excreted by the body through the skin and kidneys and in the feces. Ø Topical fluoride is applied directly to the teeth through the use of fluoridated toothpastes and mouth rinses and topical applications of rinses, gels, foams, and varnishes. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -5 Various forms of topical fluoride. Copyright © 2009, 2006 by Saunders,

How Does Fluoride Work? Preeruptive development: Before a tooth erupts, a fluid-filled sac surrounds it. Systemic fluoride present in this fluid strengthens the enamel of the developing tooth and makes it more resistant to acid. Posteruptive development: After eruption, fluoride continues to enter the enamel and alter the structure of the enamel crystals. These fluoride-enriched crystals are less acid soluble than the original structure of the enamel. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Safe and Toxic Levels of Fluoride The fluorides used in the dental office have been proved safe and effective when used as recommended. Chronic overexposure to fluoride, even at low concentrations, can result in dental fluorosis in children younger than 6 years with developing teeth. Acute overdosage of fluoride can result in poisoning or even death. Acute overdosage is very rare. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 15 Lesson 15. 3 Copyright © 2009, 2006 by Saunders, an imprint of

Learning Objectives Describe the purpose of a fluoride-needs assessment. Identify sources of systemic fluoride. Discuss three methods of fluoride therapy. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fluoridated Water For more than 40 years, fluoride has been safely added to the communal water supply. Most major cities in the United States have fluoridated water, and efforts to fluoridate water in other communities continue. From a public-health standpoint, fluoridation of public water supplies is a good way to deliver fluoride to lower socioeconomic populations who may not otherwise have access to topical fluoride products such as fluoridated toothpaste and mouth rinses. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fluoridated Water (Cont’d) Until recently it was believed that water fluoridation was effective in preventing tooth decay as a result of systemic uptake and incorporation of fluoride into the enamel of developing teeth. It has now been proved that the major effects of water fluoridation are topical, not systemic. Topical uptake means the fluoride diffuses into the surface of the enamel of an erupted tooth rather than being incorporated into unerupted teeth during development. (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fluoridated Water (Cont’d) Approximately 1 part per million (ppm) of fluoride in drinking water has been specified as the safe and recommended concentration to aid in the control of dental decay. This is approximately equivalent to one drop of fluoride in a bathtub of water. The levels of fluoride in controlled water fluoridation are so low that there is no danger of ingesting an acutely toxic quantity of fluoride. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fluoride Precautions To prevent patients from receiving too much fluoride: Evaluate the patient’s current fluoride intake. Ø Perform a fluoride-needs assessment. Ø Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -6 A, Mild fluorosis. Copyright © 2009, 2006 by Saunders, an imprint

Fig. 15 -6 B, Moderate fluorosis. Copyright © 2009, 2006 by Saunders, an imprint

Sources of Systemic Fluoride Foods and beverages: Many processed foods and beverages are prepared with fluoridated water. Dietary fluoride supplements may be prescribed by the dentist for children ages 6 months to 16 years. NOTE: Toothpaste and mouth rinses containing fluoride should not be used as a source of systemic fluoride because with proper use any excess is spit out and never swallowed. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -7 Fluoride can be dispensed by the dentist in a tablet form.

Sources of Topical Fluoride Toothpaste containing fluoride is the primary source of topical fluoride. Fluoride mouth rinses Prescription Ø Nonprescription Ø Brush-on fluoride gel Professional topical fluoride applications Fluoridated water Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -8 Prescription-strength (0. 2% sodium fluoride) mouth rinse and (1. 1% sodium fluoride) dentifrice are effective in preventing dental decay. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -10 Training toothpaste for young children. Copyright © 2009, 2006 by Saunders,

Fig. 15 -11 Various chemotherapeutic products are available to consumers. (Courtesy of Oral-B Laboratories.

Chapter 15 Lesson 15. 4 Copyright © 2009, 2006 by Saunders, an imprint of

Learning Objectives Explain the steps in analyzing a food diary. Compare and contrast the methods of toothbrushing techniques. Describe the process for cleaning a denture. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Nutrition and Dental Caries Without dietary sugars, dental caries will not occur. Sucrose has a greater decay-causing potential than other sugars, but maltose, lactose, glucose, fructose, and their combinations do have high caries-producing capabilities. Flour and starches are not usually decaycausing, but when starch is used in conjunction with sugar, (e. g. , in cookies), the potential for caries increases. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Sugar Substitutes Use of less fermentable and noncariogenic (caries-causing) artificial sweeteners has increased in recent years. Artificial sweeteners are an alternative to sucrose: Saccharine (“Sweet and Low”) Ø Aspartame (“Nutra. Sweet, ” “Equal”) Ø Sorbitol Ø Xylitol Ø Mannitol Ø (Cont’d) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Sugar Substitutes (Cont’d) Of these sugar substitutes, saccharine, aspartame, sorbitol and mannitol are noncariogenic—which means that they do not cause dental caries, Xylitol is the only one of the artificial sweeteners that actually prevents caries (anticariogenic). Products that contain xylitol are significantly better; however, they are also more expensive than products containing other types of artificial sweeteners. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -12 Ford Extreme Xylitol gum and Sugar Free Dental Care gum containing

Dietary Analysis A dietary analysis is done to determine the patient’s current food intake as a means of assessing the need for dietary counseling. The patient maintains a food diary that includes everything he or she consumes each day for 1 week. The listing includes all meals, supplements, gum, snacks, and fluoridated water. It can be used to reveal any dietary habits that are likely to have an adverse effect on the patient’s oral health. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Plaque-Control Program Plaque can be kept under control with the use of brushing, flossing, interdental cleaning aids, and antimicrobial solutions. A goal of the program is to remove plaque at least once daily. The techniques that are selected must be based on the needs and abilities of the individual patient. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Oral Hygiene Aids and Methods There a wide variety of oral hygiene products on the market today. It is important for dental assistants to remain current on the newest products on the market so that they can advise patients, make recommendations, and answer questions. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

The Toothbrush The two basic types of toothbrushes are: Manual Ø Automatic Ø Used properly, both types are effective in the removal of dental plaque. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -14 Examples of manual toothbrushes. (From Newman M, et al, editors: Carranza's clinical periodontology, ed 10, St Louis, 2006, Saunders. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -15 Positioning the powered toothbrush head and bristle tips sot that they reach the gingival margin is critical to achieving the most effective cleaning results. A, Straight head placement. B, Round -head placement. (From Newman M, et al, , editors: Carranza's clinical periodontology, ed 10, St Louis, 2006, Saunders. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Toothbrushing Precautions The patient should be cautioned about damage that may be caused by vigorously scrubbing the teeth with any toothbrush. Over time this practice may cause abnormal abrasion (wear) of the tooth structure, gingival recession, and exposure of the root surface. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -17 Observing toothbrushing technique. Copyright © 2009, 2006 by Saunders, an imprint

Fig. 15 -18 Improper brushing techniques can result in abrasion of the tooth surface and can cause gingival recession. (Courtesy of Dr. Robert Meckstroth. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Toothbrushing Methods There are several methods of toothbrushing: Bass method Ø Modified Bass Ø Charter method Ø Stillman method Ø Fones method Ø The dental professional will recommend the method best suited to the patient’s needs. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Dental Floss Dental floss or tape removes bacterial plaque and thus reduces interproximal bleeding. Dental floss is circular in shape; dental tape is flat. Floss and tape can be purchased in various colors and flavors. Floss and tape are available in waxed and unwaxed varieties. Research has shown that there is no difference in the effectiveness of waxed and unwaxed floss in removing plaque. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -19 The dental assistant helps the patient learn to floss. Copyright ©

Interdental Aids End-tuft brushes Bridge cleaners Automatic flossers Perio-Aid Copyright © 2009, 2006 by

Fig. 15 -21 An interdental hygienic aid. A, Anterior teeth. B, Cleaning posterior interproximal areas that are difficult to reach. A B Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -22 A bridge threader is used as an aid to clean under

Fig. 15 -23 Powered flossing devices can be easier for some patients to use than handheld floss. (From Newman M, et al, editors: Carranza's clinical periodontology, ed 10, St Louis, 2006, Saunders. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -24 Perio-Aid. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier

Fig. 15 -25 Denture and denture brush. Copyright © 2009, 2006 by Saunders, an

Dentifrice (Toothpaste) Dentifrice (toothpaste) contains ingredients designed to help remove food residue and abrasives to help remove stains. Highly polished tooth surfaces will stain less readily and remain clean longer. Most brands of toothpaste now contain fluoride. They also contain flavoring agents to give the mouth a fresh, clean feeling. Some toothpastes now contains a compound that reduces calculus formation when used regularly after dental prophylaxis. Ø These toothpastes will not remove existing calculus. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -26 Toothpaste for children. Copyright © 2009, 2006 by Saunders, an imprint

Mouth Rinses Many patients like the feeling of freshness provided by a mouth rinse. A wide variety of mouth rinses are available today, and some contain fluoride. Recovering alcoholics should select a mouth rinse that does not contain alcohol. Rinsing the mouth with water is recommended after meals and snacks when toothbrushing and interdental cleaning are not possible. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -27 Mouth rinses. A, Two prerinses (left) and several alcohol-free mouthrinses (right). B, Familiar brands of mouthrinses containing alcohol ranging from 8% to 27%. (Courtesy of Dr. W. B. Stilley II, Brandon, Miss. ; from Daniel SJ, Harfst SA: Mosby’s dental hygiene concepts, cases, and competencies– 2004 update, St Louis, 2004, Mosby. ) A Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved. B

Irrigation Devices Oral irrigators deliver a pulsating stream of water or chemical agent through a nozzle to the teeth and gingiva. Oral irrigation can be applied at home by the patient or in the dental office. Oral irrigation helps keep levels of subgingival bacterial to a minimum. In selected patients, oral irrigation can be used to supplement other oral hygiene techniques. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Fig. 15 -28 Irrigator (or dental water jet). The unit shown comes with standard jet tips for general cleaning, a subgingival tip which is placed below the gingival margin, tongue cleaners to help remove odor causing bacteria, and an orthodontic tip that is ideal for cleaning around braces or other dental work. The unit accepts most mouthwashes and antimicrobial agents. (Courtesy of Water. Pik Inc, Fort Collins, Colo. ) Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.

General Guidelines for Home Care Products The ADA Council on Dental Therapeutics conducts an independent review of the scientific evidence of the research claims and evaluation of home care products. When a product meets the appropriate standards, it is given the ADA Seal of Acceptance. The Seal of Acceptance provides a quality-assurance guarantee for consumers and professionals. Check the ADA's website, www. ada. org, for current information on toothbrushes, dentifrices, interproximal aids, and products for the prevention of gingivitis and caries. Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.